Conflict Management

Author

Jean-Louis Vincent

Head, Department of Intensive Care,

Erasmus Hospital, Free University of

Brussels, Belgium

Conflict arises in all fields and workplaces and in ICU Management we are not immune to issues of disagreement. On the contrary, our unique role as physicians to patients and managers to staff puts us in a seemingly inevitable and continuous environment of conflict. Whether we must mediate a disagreement between doctors and nurses in our departments, or resolve a dispute involving the course or termination of care with a patients’ family, we often need to manage difficult situations in the absence of clear guidelines to lead our decision making process.

In this issue of ICU Management, we tackle the ethics and resolution practices involved with the broad range of disputes we encounter on a daily basis. Dr. Hawryluck and Dr. Lawless from Toronto General and St. Michaels Hospitals in Toronto, Canada outline ethical principles related to development of conflict resolution policy, while Senior Policy Analyst Nathalie Danjoux explains common causes and recommendations for preventing conflicts in interactions with patients and their families. Kathleen Bartholomew utilises her experience on the other side of the spectrum to advise on best practises for avoiding and resolving conflicts between nurses themselves as well as between nurses and doctors.

In order to continue to provide articles of innovative techniques in critical care, we have included a Special Focus on Hypothermia in this issue of ICU Management. Prof. Polderman of University Medical Centre in Utrecht, The Netherlands discusses the cost-effectiveness of induced hypothermia and Prof. Idrissi of University Hospital Brussels, in Belgium explores the limits of the use of hypothermia in his articles on mild hypothermia as treatment in both cerebral ischaemic insult and cardiac arrest. Dr. Gene Sung of the University of Southern California in Los Angeles, California summarises promising research with respect to the use of hypothermia in acute ischaemic stroke.

Drs. Rothen and Mende have contributed an enlightening and timely article on special considerations in caring for obese patients in the ICU for our Management focus. We turn our attention to Norway for our Country Focus, where Dr. Hans Flaatten chronicles recent ICU cases that have captured the public’s interest and stimulated a myriad of changes in ethical and decision-making guidelines in futility cases. In addition, Dr. Nils Smith-Erichsen, an ICU consultant, delves into his personal experiences and opinions about the challenges and advantages of working in a Norwegian intensive care in this issues’ interview.

Be sure not to miss the preview for this year’s Society of Critical Care Medicine’s annual congress in Hawaii followed by an update on the highly anticipated preliminary results of the Epic II Study.

As ICU managers, we are continually faced with obstacles that stretch our skills as clinicians and challenge the limits of our management expertise. We hope that our focus on conflict management– both in terms of methods of prevention and policies for resolution will help you to overcome disputes that you confront on a daily basis.